scholarly journals SUN-513 Severe Hyperthyroidism in a Complete Molar Pregnancy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Nikoletta Proudan ◽  
Kersthine Andre
Keyword(s):  
Perioperative Complications ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Thyroid Storm ◽  
Molar Pregnancy ◽  
Free T4 ◽  
Trophoblastic Disease ◽  
Increased Risk ◽  
History Of

Abstract Hydatidiform mole (HM), a type of gestational trophoblastic disease (GTD), is a rare cause of clinical hyperthyroidism. The development of hyperthyroidism requires an elevation of HCG >100,000 mlU/mL for several weeks. Complete mole has a marked HCG elevation compared to partial mole thus presents with a higher incidence of thyrotoxicosis. Surgical uterine evacuation is the treatment of choice for HM. However, untreated hyperthyroidism can pose a risk for the development of thyroid storm and high-output cardiac failure in the perioperative period. To our knowledge, there are no specific guidelines for management at this time. We present a case of hyperthyroidism secondary to complete molar pregnancy successfully treated with propylthiouracil (PTU), potassium iodide (SSKI), and atenolol in the preoperative period. A 42-year-old female with history of migraines presented to her gynecologist with a 3-week history of lower abdominal cramping, vomiting, loss of appetite, and abnormal vaginal bleeding. She also endorsed a 6-pound weight loss, intermittent tachycardia, exertional dyspnea, and increased anxiety. Pregnancy test was positive, and ultrasound was concerning for GTD. Laboratory work up was significant for HCG 797,747 mIU/mL (< 5mlU/mL), TSH <0.005 mIU/mL (0.4-4.0 mlU/mL), Free T4 3.09 ng/dL (0.9-1.9 ng/dL), and Free T3 11.48 pg/dL (1.76-3.78 pg/dL). The patient was admitted to the hospital and started on PTU 100 mg Q6H, SSKI 200 mg TID following the first dose of PTU, and atenolol 25 mg daily. She underwent an uncomplicated D & C the next day. On post-op day 1, HCG decreased to 195,338 mIU/mL and Free T4 to 2.39 ng/dL. The patient was discharged on the aforementioned doses of PTU and atenolol. One-week follow-up labs showed HCG 8,917 mIU/mL and Free T4 1.22 ng/dL. Surgical pathology confirmed a complete hydatidiform mole. PTU was decreased to 50 mg TID. On post-op day 14, HCG had risen to 15,395 mIU/mL with onset of nausea and vomiting. Repeat Free T4 remained within reference range. Patient was taken back to surgery for a laparoscopic total hysterectomy with bilateral salpingectomy. Pathology confirmed an invasive hydatidiform mole. Two-week follow-up lab work showed HCG 155 mIU/mL, TSH 1.5 mIU/mL, and Free T4 1.19 ng/dL. PTU and atenolol were then discontinued. The development of hyperthyroidism in molar pregnancy is largely influenced by the level of HCG and usually resolves with treatment of GTD (1). However, it’s crucial to control thyrotoxicosis to avoid perioperative complications. This case also highlights the importance of monitoring HCG levels following a complete molar pregnancy due to an increased risk for invasive neoplasm. 1. Walkington, L et al. “Hyperthyroidism and human chorionic gonadotrophin production in gestational trophoblastic disease.” British journal of cancer vol. 104,11 (2011): 1665-9. doi:10.1038/bjc.2011.139

scholarly journals MOLAR ECTOPIC PREGNANCY;

2013 ◽  
Vol 20 (04) ◽  
pp. 638-641
Author(s):  
SHAMA CHAUDHARY ◽  
IQRA JANGDA ◽  
RUBINA HUSSAIN
Keyword(s):  
Ectopic Pregnancy ◽  
Iliac Fossa ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Trophoblastic Disease ◽  
Beta Hcg ◽  
History Of ◽  
The Right

Ectopic molar pregnancy is a rare occurrence. Clinical diagnosis of a molar pregnancy is difficult but histopathology is thegold standard for diagnosis. The management of ectopic molar pregnancies consists of surgically removing the conceptus, follow up &chemotherapy, if required. We are reporting a case report of a 35-year-old married, nulliparous woman, admitted in emergency with a 6-week history of amenorrhea, severe abdominal pain & an episode of fainting at home. Per abdominal examination revealed tendernessover the right iliac fossa, with guarding & rigidity. Diagnosis of ruptured ectopic pregnancy was made.Emergency laparotomy was done.Histopathological examination, showed tubal ectopic pregnancy with partial hydatidiform mole & a separate corpus luteal cyst.She wasfollowed up with serial beta hCG which became normal within 1 month. Although ectopic molar pregnancy is a rare entity but all ectopicpregnancies should be examined histologically to rule out presence of gestational trophoblastic disease to plan follow-up accordingly inorder to avoid persistent gestational trophoblastic disease which has a chance of malignant conversion.The prognosis of ectopic molarpregnancies is the same as for other forms of gestational trophoblastic disease.

scholarly journals Does hysteroscopy in women with persistent gestational trophoblastic disease reduce the need for chemotherapy? A prospective, single-arm, clinical trial pilot study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Fatemeh Davari Tanha ◽  
Saghar Samimi Sede ◽  
Fariba Yarandi ◽  
Elham Shirali ◽  
Maliheh Fakehi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Trophoblastic Disease ◽  
Beta Hcg ◽  
Significant Difference ◽  
History Of ◽  
The Mean ◽  
Trophoblastic Tissue

Abstract Background This study aimed to describe the efficacy of hysteroscopy in the management of women with the persistent gestational trophoblastic disease (PGTD)/GTN to reduce the need for chemotherapy. Materials and methods This prospective, single-arm, clinical trial study was recruited in an educational referral hospital between September 2018 and September 2019. Totally, 30 participants with a history of hydatidiform mole that was managed by uterine evacuation and developed low risk persistent gestational trophoblastic disease were recruited. Hysteroscopy was performed for removal of persisted trophoblastic tissue. Serum beta-hCG titer was measured before and 7 days after the procedure. Results The mean ± SD age of the participants was 31.4 ± 4.6 years. There was a significant difference (p = 0.06) between that mean ± SD of beta-hCG titer before (8168.4 ± 1758) and after (2648.8 ± 5888) hysteroscopy. Only two (6.6%) cases underwent chemotherapy due to no drop in the beta-hCG titer. Conclusion Hysteroscopy may play a significant role in the management of GTN, although it requires validation in larger prospective randomized studies and longer follow-up.

scholarly journals SUN-009 Variable Presentation of Two Patients with Gestational Trophoblastic Disease and Hyperthyroidism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Bettina Chale-Matsau ◽  
Samantha Mokoena ◽  
Tanja Kemp ◽  
Tahir S Pillay
Keyword(s):  
Ct Scan ◽  
Metastatic Disease ◽  
Pulse Rate ◽  
Medical Oncology ◽  
Gestational Trophoblastic Disease ◽  
Thyroid Storm ◽  
Molar Pregnancy ◽  
Free T4 ◽  
Trophoblastic Disease ◽  
Β Hcg

Abstract Background: Gestational trophoblastic disease (GTD) represents a group of tumours caused by abnormal proliferation of trophoblastic cells, including molar pregnancy. Elevated β-hCG levels are an established marker for the presence of the disease and useful for monitoring. Due to the shared structural homology of β-hCG and TSH, hyperthyroidism can occur. Clinical Cases: We present two patients with GTD associated with hyperthyroidisim. Case 1, a 20 year old female (G1P0) presented to the emergency department complaining of vaginal bleeding associated with abdominal pain. She was estimated to be 13 weeks. Laboratory evaluation were β-hCG 648 324 IU/L, TSH 0.06 (0.35 - 4.94 mIU/L, free T4 23.2 (9.0 - 19.0 pmol/L, Hb 8.0 (11.6 - 16.4 g/dL). Ultrasound revealed molar pregnancy. She underwent uterine evacuation, thereafter complicated with thyroid storm (Burch Wartofsky score = 45). Post- operative vitals were BP 192/112, pulse rate 120 bpm and temperature 360C. She was managed in high care on labetolol, carbimazole, lugol’s iodine and hydrocortisone. She was subsequently referred to Medical Oncology for further management. Histology sample obtained in theatre confirmed complete molar pregnancy. Her staging CT scan indicated the presence of small lung nodules, suggesting metastatic disease. The patient’s FIGO/WHO score was III: 2. At the time of preparing this study, she had already received 7 weeks of methotrexate intramuscularly and still had detectable β-hCG levels. Case 2 was a 31 year old female presented similarly. This was her second pregnancy (G2P1), 12 weeks by dates. Her vitals were BP 141/74, pulse rate 110 bpm and temperature 36oC. The Ultrasound revealed larger for gestational age uterus with cystic structures in utero. Her quantitative β-hCG was significantly elevated (> 1 500 000 IU/L) she was thyrotoxic [TSH (<0.1 (0.34 - 4.94 mIU/L) free T4 (47.2 (9.0 - 19.0 pmol/L)], however did not develop thyroid storm (Burch Wartofsky score = 20). This patient also underwent uterine evacuation and did well post operatively. She was treated for her thyrotoxicosis with carbimazole, propranolol and thiamine. Further management was by Medical Oncology. Histological examination was in keeping with a partial mole. Her staging CT scan showed no metastasis, and had a FIGO/WHO score of 1: 4 due to her pre-treatment hCG of >1.5 million IU/L. She received 7 cycles of intramuscular methotrexate from which she achieved and maintained suppressed β-hCG levels (<1 IU/L). Conclusions: This study has demonstrated that the β-hCG levels may not always correlate with disease severity and prognosis. When comparing the two patients Case 1 had lower levels of β-hCG and of free T4 than Case 2, however was clinically more unwell, developed thyroid storm and had metastatic disease. Case 2 had hCG levels almost double those of Case 1, wsa stable and her levels decreased much quicker reaching undetectable levels

Complete Hydatidiform Mole and Coexisting Fetus With Gastroschisis: A Case Report Highlighting the Importance of Diagnostic Genotyping

2021 ◽  
pp. 109352662110248
Author(s):  
Austin McHenry ◽  
Urania Magriples ◽  
Pei Hui ◽  
Raffaella Morotti
Keyword(s):  
Differential Diagnosis ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Diagnostic Process ◽  
Rare Occurrence ◽  
Complete Hydatidiform Mole ◽  
Trophoblastic Disease ◽  
Increased Risk ◽  
Ancillary Studies

Twin pregnancy with a complete hydatidiform mole and a coexisting fetus (CHMCF) is an extremely rare occurrence, described only by a handful of published series and cases reports. The majority of the literature on CHMCF examines prenatal care and follow-up in relation to the increased risk of gestational trophoblastic neoplasia (GTN). At present, few reports elaborate on the diagnostic process and differential diagnosis, especially in the context of recent molecular advances in risk stratification for GTN. Here, we describe the first known case of a CHMCF with gastroschisis with liveborn delivery at 35 weeks gestation. This report aims to review the pre- and postnatal differential diagnosis and discuss recent updates on the importance of ancillary studies in the diagnosis of gestational trophoblastic disease.

Changing Trends in the Clinical Presentation and Management of Complete Hydatidiform Mole Among Brazilian Women

2016 ◽  
Vol 26 (5) ◽  
pp. 984-990 ◽  
Author(s):  
Antonio Braga ◽  
Valéria Moraes ◽  
Izildinha Maestá ◽  
Joffre Amim Júnior ◽  
Jorge de Rezende-Filho ◽  
...  
Keyword(s):  
Natural History ◽  
Early Diagnosis ◽  
Clinical Symptoms ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Complete Hydatidiform Mole ◽  
Trophoblastic Disease ◽  
History Of

ObjectiveThe aim of the study was to evaluate potential changes in the clinical, diagnostic, and therapeutic parameters of complete hydatidiform mole in the last 25 years in Brazil.MethodsA retrospective cohort study was conducted involving the analysis of 2163 medical records of patients diagnosed with complete hydatidiform mole who received treatment at the Rio de Janeiro Reference Center for Gestational Trophoblastic Disease between January 1988 and December 2012. For the statistical analysis of the natural history of the patients with complete molar pregnancies, time series were evaluated using the Cox-Stuart test and adjusted by linear regression models.ResultsA downward linear temporal trend was observed for gestational age of complete hydatidiform mole at diagnosis, which is also reflected in the reduced occurrence of vaginal bleeding, hyperemesis and pre-eclampsia. We also observed an increase in the use of uterine vacuum aspiration to treat molar pregnancy. Although the duration of postmolar follow-up was found to decline, this was not accompanied by any alteration in the time to remission of the disease or its progression to gestational trophoblastic neoplasia.ConclusionsEarly diagnosis of complete hydatidiform mole has altered the natural history of molar pregnancy, especially with a reduction in classical clinical symptoms. However, early diagnosis has not resulted in a reduction in the development of gestational trophoblastic neoplasia, a dilemma that still challenges professionals working with gestational trophoblastic disease.

A Study of Molar Pregnancy at Low Resource Settings of Tertiary Care Hospital Sindh

2021 ◽  
Vol 15 (7) ◽  
pp. 1547-1549
Author(s):  
Sabahat Fatima ◽  
A. G.ul Shaikh ◽  
Tahmina Mahar ◽  
Hameed-Ur-Rehman Bozdar ◽  
Sameena Memon ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Economic Status ◽  
Gestational Trophoblastic Disease ◽  
Common Symptom ◽  
Care Hospital ◽  
Molar Pregnancy ◽  
Socio Economic Status ◽  
Trophoblastic Disease

Aim: To determine the epidemiological factors/characteristics and clinical presentation of molar pregnancy Study design: Qualitative observational / retrospective study Place and duration: Department of Obstetrics and Gynaecology Unit-II, Ghulam Muhammad Mahar Medical College Sukkur from 1st January 2016 to 31st December 2020. Methodology: Forty five diagnosed cases with molar pregnancy and aged between 18-40 years were enrolled. Patient’s details demographics age, body mass index, parity and socio economic status were recorded. The total birth records and gynecological admission for the study period were also collected from the gynaecology and labour room record books case and operational registration data were obtained, descriptive statistics examined . Results: Mean age of the patients was 31.15±7.41 years with mean body mass index 26.16±7.22 kg/m2. Mean gestational age of the patients were 25.62±9.19 weeks. Twenty seven (60%) patients were multiparous and 18 (40%) were primiparous. 30 (66.7%) were illiterate and 15(33.3%) cases were literate. There were 14(31.11%) patients belonged lower class, 18 (40%) patients belonged middle and 13(28.9%) had high socioeconomic status. Twenty nine (64.4%) were from rural area and 16 (35.6%) were from urban area. Five (11.1%) patients had previous history of gestational trophoblastic disease. Abnormal vaginal bleeding was the most common symptom found in 34(75.5%) cases followed by lower abdominal pain found in 30 (66.7%) patients, hyperemesis found in 14(31.1%) and dyspnea in 9 (20%). Thirty six (80%) patients received suction evacuation and 9 (20%) cases referred. Forty one (91.1%) patients were recovered but the rest 4 (8.9%) were lost during follow up. Conclusion: Low/middle socio-economic status, illiteracy and cases from rural areas had multiparous parity was highly effected by molar pregnancy disease and it can be controlled by early diagnose to take regular follow-up by using suction evacuation. Key words: Gestational trophoblastic disease (GTD), Molar pregnancy, Primiparous, Multiparous

The clinical presentation, treatment, and outcome of patients diagnosed with possible ectopic molar gestation

2004 ◽  
Vol 14 (2) ◽  
pp. 366-369 ◽  
Author(s):  
A. M. Gillespie ◽  
E. A. Lidbury ◽  
J. A. Tidy ◽  
B. W. Hancock
Keyword(s):  
Risk Factors ◽  
Clinical Presentation ◽  
Gestational Trophoblastic Disease ◽  
Surgical Removal ◽  
Molar Pregnancy ◽  
Initial Management ◽  
Trophoblastic Disease ◽  
Treatment Centre ◽  
History Of ◽  
Park Hospital

The objective of this study was to determine the clinical presentation, treatment, and outcome of patients diagnosed with possible ectopic molar gestation registered with the Trophoblastic Disease Screening and Treatment Centre, Weston Park Hospital, Sheffield between 1986 and 2000. From the 5581 women registered, those with a diagnosis of ectopic molar pregnancy were identified from a computer database. Information regarding the relevant history of each patient and the clinical presentation, treatment, and outcomes of gestational trophoblastic disease (GTD) was determined by reviewing referral forms, case notes, and pro formas completed by the referring gynecologist. Histological review of the cases was undertaken where possible. Suspected ectopic molar gestations comprised 31/5581 (0.55%) of registrations. Known risk factors for ectopic pregnancy were identified in 79% of cases. Central histological review confirmed only six cases of GTD: three choriocarcinoma and three early complete moles. Four patients subsequently required chemotherapy. All patients are now in complete remission. We conclude that ectopic GTD is uncommon, with a UK incidence of approximately 1.5 per 1,000,000 births. Initial management is usually surgical removal of the conceptus, pathological suspicion of the diagnosis and registration with a screening center. Chemotherapy may be required and the prognosis is excellent.

scholarly journals Genetic Screening of Susceptible Women to Recurrent Molar Pregnancy for Prevention of Gestational Choriocarcinomas

2021 ◽  
Author(s):  
Khalil Khashei Varnamkhasti
Keyword(s):  
Hydatidiform Mole ◽  
Gene Mutations ◽  
Clinical Importance ◽  
Recessive Gene ◽  
Middle Layer ◽  
Gestational Trophoblastic Disease ◽  
Compound Heterozygous ◽  
Molar Pregnancy ◽  
Gestational Choriocarcinoma ◽  
Increased Risk

Hydatidiform mole is an abnormal pregnancy characterized by hyper-proliferation of trophoblastic cells (both cytotrophoblast and syncytiotrophoblast). If the proliferation phenomenon not well controlled, e.g. due to poor medical health care system, mole can become invasive and lead to gestational choriocarcinomas. Gestational choriocarcinoma by strong metastatic potentiality, as one of the most aggressive, malignant form of gestational trophoblastic disease, could be spread through directly vascular and the middle layer of the uterine wall (Myometrium‎) and would involve distant sites such as the lungs, spleen, intestines, kidney, and liver. When a hydatidiform mole occurs once, it is known as sporadic hydatidiform mole; if it happens again, the condition is known as recurrent hydatidiform mole. In recurrent form, the gestational choriocarcinoma occurrence risk increased up to a 100-fold. Therefore, early onset identify of susceptible women to recurrent molar pregnancy is clinical importance because of the increased risk of developing neoplasia. Due to the role of maternal homozygous and compound heterozygous recessive gene, mutations have been reported in hydatidiform mole occurrence, women screening can be improved by molecular genotyping methods.

scholarly journals Recurrent Thyroid Storm Caused by a Complete Hydatidiform Mole in a Perimenopausal Woman

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Anuradha Jayasuriya ◽  
Dimuthu Muthukuda ◽  
Preethi Dissanayake ◽  
Shyama Subasinghe
Keyword(s):  
Molecular Mimicry ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Thyroid Storm ◽  
High Dose ◽  
Complete Hydatidiform Mole ◽  
Free Triiodothyronine ◽  
Rare Presentation ◽  
Perimenopausal Woman ◽  
Trophoblastic Disease

Background. Gestational trophoblastic disease (GTD) which includes hydatidiform mole, invasive mole, placental site trophoblastic tumor, and choriocarcinoma is a rare cause of hyperthyroidism due to excess production of placental human chorionic gonadotrophin hormone (hCG) by tumor cells. Molecular mimicry between hCG and thyroid stimulating hormone (TSH) leads to continuous stimulation of TSH receptor by extremely high levels of hCG seen in these tumors. Consequently, biochemical and clinical hyperthyroidism ensues and it is potentially complicated by thyrotoxic crisis which is fatal unless urgent therapeutic steps are undertaken. Case Description. We present a 49-year-old perimenopausal woman who presented with recurrent thyroid storm and high output cardiac failure. The initial workup revealed suppressed TSH, high-free thyroxine (FT4), and free triiodothyronine (FT3) levels with increased vascularity of the normal-sized thyroid on ultrasonography. She was managed with parenteral beta blockers, steroids, and high-dose carbimazole. Her lower abdominal tenderness led to further investigations which revealed tremendously elevated beta-hCG and a snow storm appearance on transabdominal ultrasound suggestive of GTD. She underwent curative surgery and was diagnosed with complete hydatidiform mole postoperatively by histology. Conclusion. Recurrent thyroid crisis in gestational trophoblastic disease is an exceedingly rare presentation and that is highly fatal. This case highlights the importance of early detection and treatment of the etiology of thyrotoxicosis to eliminate mortality.

Successful use of anti-retroviral therapy in combination with cytotoxic chemotherapy for persistent molar pregnancy: A case report

2003 ◽  
Vol 13 (2) ◽  
pp. 246-248
Author(s):  
M. Moodley ◽  
J. Moodley
Keyword(s):  
Case Report ◽  
Antiretroviral Therapy ◽  
Young Women ◽  
Ethical Dilemmas ◽  
Gestational Trophoblastic Disease ◽  
Cytotoxic Chemotherapy ◽  
Molar Pregnancy ◽  
Trophoblastic Disease ◽  
Response To Chemotherapy

Due to the HIV pandemic, the chances of finding gynecological malignancies in HIV-infected women are increased. This poses management and ethical dilemmas as the treatment for such malignancies are likely to further decrease their immunity. Gestational trophoblastic disease occurs predominantly among young women and has excellent response to chemotherapy. However, such therapy is not possible if their immunity (CD4 counts) is markedly depressed. The patient described presented with persistent molar pregnancy and had low CD4 count. She was given antiretroviral therapy and once the CD4 count had risen to acceptable levels cytotoxic chemotherapy was administered. She received a total of 13 cycles of chemotherapy with no significant untoward effects. After a 6-month follow-up period the patient was well with a negative serum βHCG level and CD4 count above 200. We conclude that HIV-infected women with gestational trophoblastic disease may be safely treated with cytotoxic chemotherapy provided anti-retroviral therapy is concurrently administered to boost immunity.

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